Neurosurgical management of pain

Neurosurgical interventions for the management of pain can broadly be categorized as anatomic, neuromodulatory and neuroablative. Spinal cord stimulation (SCS) was first used as treatment modality for cancer pain in the 1960s. The surgical technique evolved from subdural electrode placement, to intradural placement to epidural placement today. The increased use of SCS and intrathecal drug delivery has led to a decrease in the use of neuroablative procedures to manage pain. Neuromodulatory procedures include both drug infusion therapies and neurostimulation procedures such as peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation and deep brain stimulation. In contrast, neuroablative procedures seek to interrupt the pathways of pain transmission and may be directed towards the peripheral nerve, root entry zone, spinal cord or brain.